Effect of frailty on recovery after fast-track elective laparoscopic surgery in geriatric patients

Abstract

Objective To explore the predictive value of pre-operative comprehensive geriatric assessment (CGA), especially regarding frailty, on the outcomes of fast-track surgery and the risk of post-operative complications after elective laparoscopic surgery in geriatric patients. Methods This prospective study included 75 patients aged 70 years and above undergoing elective laparoscopic surgery from June 2015 to October 2015.CGA was conducted with length of postoperative hospitalization, all-cause mortality and postoperative complications as the endpoints. Results The mean length of hospital stay after surgery was 9.7 day (9.7±7.3) and was correlated with frailty scores (P=0.015) and comorbidities (P=0.004). Multivariate Logistic regression analysis showed that frailty (OR=5.26, 95%CI: 1.22-22.55, P=0.025) and comorbidity (OR=5.12, 95%CI: 1.63-15.99, P=0.005) were predictors of prolonged hospitalization after surgery.Seventeen of 75 patients (22.7%) experienced at least one adverse postoperative outcome, and bivariate analysis showed that adverse events were correlated with poor nutrition (P=0.012), high frailty scores (P=0.007), and multiple comorbidities (P=0.005). Furthermore, multiple regression analysis identified malnutrition (OR=4.30, 95%CI: 1.03-17.86, P=0.045), comorbidity (OR=5.41, 95%CI: 1.47-19.83, P=0.011) and frailty (OR=6.03, 95%CI: 1.39-26.10, P=0.016) as predictors of adverse postoperative outcomes. Conclusions Frailty is a risk factor for elderly patients undergone fast-track laparoscopic surgery, and preoperative CGA scores may be used to identify high-risk patients for adverse surgical outcomes and prolonged hospital stay. Key words: Frailty; Risk assessment; Laparoscopy; Rehabilitation